U.S.A. Rentals Only


15838 N 62nd Street Scottsdale AZ 85254-1988
Telephone: 800-VIDEO 74 (800-843-3674) 480-596-9970 Fax: 480-596-9973

Instructions: Complete this form, then click on the Submit icon or
Print this form and fax to 480-596-9973

* = Required Field

State:*   Zip:*
Your Email:*  
Phone:*   Fax

Enter Video Order # and Title in the Spaces Provided

Order #   Title
Order #   Title
Order #   Title
Order #   Title
Order #   Alternate Title
Order #   Alternate Title
  If you have a Rental Membership Identification Number enter it below

Please "x" the type of order you are placing

  Internet Special
This is a 4-tape video rental. All 4 tapes can be rented for $29.95 plus shipping. You agree to return the videos you select within 14 days from the date of receipt. Round-trip shipping for all 4 videos is $10.00
  Rental Member Pricing
You may rent up to 3 videos for $8.00 per tape. You agree to return the videos you select within 14 days from the date of receipt. Round-trip shipping for 1, 2 or all 3 videos is $8.00.

We Gladly Accept

We also welcome your personal or company check and money orders.
In the event your first selections are not available please include 2 alternate video titles in the spaces above.
Enter Your Credit Card Number with Expiration date in the space below

Credit or Debit Card #
Expiration Date

How did you hear about us?

If Paying By check

Note:   Please make your check payable to Video Learning Library and mail this form with your check to the above address. Orders are shipped within 48 hours unless temporarily out of stock. Allow 2-3 weeks for back-ordered items. Express Mail and Overnight Services are available. Telephone 480-596-9970 for rates and title availability. Orders shipped to Arizona addresses will be charged 7.05% Sales Tax.

By Completing and submitting this Rental Order Form
you are agreeing to the following
"I, the undersigned, accept the rental tapes and agree to return the same in good condition within the prescribed time or to pay for repairs, replacements, or additional rental charges. I agree to maintain personal possession of rental items and agree not to lend them to anyone else. This is a rental agreement and therefore, title to rental items shall always remain with Video Learning Library, L.L.C.. If rental items are lost, stolen or destroyed, I agree to purchase such rental items at Video Learning Library's retail price for such item as of this date, less the amount of rental fees paid."

Date   Name

In-stock items will be shipped within 48 hours. Out of stock product will be back ordered. Please allow 2-3 weeks for delivery.

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